Client with whiplash injuries

To complement the article “Whiplash: Implications for Massage Therapy” in the February 2015 issue of MASSAGE Magazine. Summary: Whiplash injuries can come with debilitating physical—and emotional—complications. Massage therapy is uniquely positioned to provide relief for both.

Whiplash injuries are complicated; they can present both physical and emotional wounds, and are therefore most likely to benefit from a team approach to treatment. In order to truly work collaboratively, it is crucial to know exactly what other health care providers are expecting from massage therapists who work with them.

In speaking with other health care providers about what skills they wish to see from massage therapists, three essential skills kept surfacing. To work most effectively with whiplash sufferers, they said therapists need technical skills and ability; good collaborative skills; and sensitivity to patient communication.

Technical skills

It is essential to master palpation and treatment ability to address the specific structures involved in whiplash injuries. This requires both the knowledge base of what muscles are involved, how and when to treat them, and why. 

Physical therapist Erma Pacheco, P.T., said she would expect the massage therapist to have demonstrably precise skills to treat the scalenes, sternocleidomastoid, longus colli, splenius cervicis and capitis, and the suboccipitals. Physician John Poag, M.D., also suggested that the massage therapist should consider adding deep cross-fiber friction of the attaching ligaments and tendon attachments. His reasoning was that in hyper-flexion and extension of the neck, it is the attachments of the muscles via tendons, and the intervertebral attachments of small ligaments to the vertebrae, that get injured most frequently. His opinion is this is an important and effective element of treatment for therapists trained in deep friction of these tendons and ligaments.  


If massage therapists are to be part of a team, then good communication skills are extremely important. Pacheco said good communication with the physical therapist ensures clear direction following a thorough evaluation, which avoids issues with possible disk problems, fractures or underlying pathologies.

In her experience, a person with a whiplash injury needs specific deep tissue work twice per week for three or four weeks, with the physical therapist evaluating the patient after the first week or so. Then, the person should usually be ready to begin movement therapy with the physical therapist or physical therapy assistant one time per week, and deep tissue work one time per week for three or four weeks. Then, she said, the soft tissue work can be spread out as the person resumes work activities and receives ergonomic counseling from the physical therapist.

All along, all team members should be teaching good breathing and stress-management strategies. Poag added that although the majority of whiplash-associated disorders affect soft tissue only, and do not involve torn or protruding disks or nerve or cord impingement, any patient who has not been screened for these properly would need to be, in order to be sure there is not something going on in addition to soft tissue damage.

Sensitivity in communication

Whiplash injuries may also have very powerful emotional effects, such as hyper-arousal and hyper-vigilance. Hyper-arousal and hyper-vigilance can lead to a misinterpretation of symptoms, and avoidance or fear of movement.

Chiropractor Phillip Snell, D.C., was particularly sensitive to this issue in his comments for this article. He typically does not continue passive care recommendations for massage or other passive modalities beyond four to six weeks from the date of injury, moving at that point to more active care, patient education and reassurance. 

The goal, Snell said, is to use massage and other passive modalities to help the patient transition to more active approaches. He was careful to point out that therapists should not overemphasize tissue injury or misalignment, as these may have a negative psychological effect and therefore diminish treatment outcomes. 

An important role

Massage therapy can be uniquely positioned to maximize treatment outcomes for people who have suffered whiplash injuries. By working as part of a team with other health care providers, massage therapists can play an important role in helping whiplash sufferers return to healthy and active lives.

Douglas NelsonAbout the Author

Douglas Nelson, L.M.T., began his career in massage therapy in 1977 and maintains a very active clinical practice. He offers Precision Neuromuscular Therapy seminars ( throughout the U.S. His particular interest has been the role of soft tissue in performance. He has served as a neuromuscular consultant to NBA and NFL teams, as well as high-level musicians. He wrote the MASSAGE Magazine article, “Whiplash: Implications for Massage Therapy” (February 2015).